Asthma

Updated 15 February 2017

Low-income kids more likely to have asthma

Asthma is more prominent among children from low-income areas while autism is more often diagnosed among children from higher-income families, a new study finds.

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    Children in families struggling to make ends meet are developing asthma and attention-deficit/hyperactivity disorder (ADHD) at faster rates than kids from families with greater means, a new study finds.

    On the other hand, kids from wealthier families are being diagnosed with autism spectrum disorder more often than children in poorer homes. But that likely indicates that those parents have better access to the health care services that can uncover an autism diagnosis, the study authors said.

    The findings suggest that family income and access to health insurance play a large role in a child's physical and mental health, said lead researcher Dr Christian Pulcini. He's a paediatrics resident with the Children's Hospital of Pittsburgh.

    The reality of poverty in SA

    For about half of all young South Africans today, the future is likely to be marked by low levels of poor education, high unemployment and restricted access to social grants, according to University of Cape Town’s  (UCT) 2015 Child Gauge report

    UCT psychologist Catherine Ward, who co-authored a Child Gauge chapter on poverty’s effects on families, previously told Health24 that poverty may not only prejudice a child’s intellectual development but also the early, close relationships that will help prepare them for the working world.

    “People who live in poverty also experience an extraordinary amount of stress,” she added. “In many neighbourhoods, especially in South Africa, poverty is coupled with violence and so parents are often frightened for their children.”

    Poverty also often prevents people from following a healthy diet, and the Heart and Stroke Foundation has urged South Africans to check their blood pressure readings and follow a healthy diet – but poverty and high food prices are putting a healthy diet out of reach of many people in the country.

    In addition, poverty can shorten one's life, and a study published in The Lancet – that analysed 48 studies, including more than 1.7 million people in the United States, the United Kingdom, Australia, France, Italy, Portugal and Switzerland – found that poor people were 46 percent more likely than wealthier people to die before age 85.

    Health programmes needed in poorer communities 

    "Children in poverty are more at risk for adverse health outcomes, and we need to keep that in mind when we make policy and programmes that will benefit children, particularly if they are poor," Pulcini said.

    For their study, Pulcini and his colleagues analysed data from the US National Survey of Children's Health, a federal survey conducted three times between 2003 and 2012.

    The investigators specifically reviewed rates of asthma, ADHD and autism for two reasons, Pulcini explained. Other studies had found all three conditions on the rise in the United States. And the disorders provided a good mix of physical (asthma) and mental (ADHD and autism) health conditions that children face.

    The study found that parent-reported rates of all three conditions are increasing. Asthma and ADHD rates rose 18 percent and 44 percent, respectively, between 2003 and 2012, while autism rates increased a whopping 400 percent.

    Family income has implications on health

    But when the researchers factored poverty into their analysis, the findings showed that family income level had a distinct effect on childhood illness:

    • Asthma rates increased nearly 26 percent among children in families at less than 100 percent of the federal poverty level (FPL), as opposed to about 15 percent in families between 100 percent and 199 percent of the FPL, and about 13.5 percent in families earning 200 percent or more of the poverty level.
    • ADHD rates were much lower for families at or above 400 percent of the federal poverty level (33 percent) than families earning less money (43 percent to 52 percent, depending on income).
    • Autism spectrum disorder was more likely to be diagnosed in kids from families above the federal poverty level (28 percent to just over 43 percent, depending on income) than those who fall below the poverty level (13 percent).

    The 2017 federal poverty level is an annual income of $20,420 for a family of three and $24,600 for a family of four, according to the US Department of Health and Human Services.

    Dr Michael Grosso is chairman of the department of paediatrics at Northwell Health's Huntington Hospital, in Huntington, New York. He said that asthma and ADHD rates among poorer families could be linked with the physical and mental strains of deprivation – a phenomenon known as "toxic stress".

    Pulcini explained that children in financially struggling families are more likely to be exposed to poorer indoor and outdoor air quality, and are less likely to eat well – two conditions that have been tied to asthma risk.

    Behavioural health also at risk

    Grosso added, "We now understand that infants and children who don't have the benefit of good nutrition, a stable home environment, regular routines and protection from violence are at risk for lasting consequences including behavioural health and other medical conditions."

    Conversely, Pulcini said, the fact that better-off children are more likely to be diagnosed with autism could be tied to their families' improved access to health resources.

    Families with more financial means "have better access to resources to identify autism. Parents have more resources to get children screened and get them treated," Pulcini said. On the other hand, children in poorer families have to undergo a more circuitous route before their autism is recognised, he said.

    "Among children who are eventually diagnosed with autism, if they are poor, they are more likely to be diagnosed with ADHD first and then autism," Pulcini noted.

    Dr Andrew Adesman, chief of developmental and behavioural paediatrics at Cohen Children's Medical Centre in New Hyde Park, New York, said the study results "emphasise how important it is to consider social risk factors for disease."

    "At a time when consideration is being given by some to limit health care coverage and other social services for the poor, the findings from this study emphasise how important it is for all children to have health insurance and other basic essentials," he said.

    The study findings were published in the journal Paediatrics.

    Read More:

    Poverty may affect the outcome of asthma treatment

    Underprivileged asthmatics face tough challenges

    Child asthma rates leveling off but not for poor kids

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    Professor Keertan Dheda has received of several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others.Read his full biography at the University of Cape Town Lung Institute

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